THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY
1. Highest point of illiac crest lies at L3/L4
disc level.

2. During development, lower limb buds rotate 90° medially whereas upper

limb buds rotate 90° laterally.

3. Obturator foramen is large, oval in males and small, triangular in females.

4. Greater sciatic notch is wider in females than males (female → 75°, male

→ 50°).

5. Subpubic angle is females is 80° - 85° (less in males).

6. Neck – shaft angle of femur : 125°. Angle of femoral torsion or angle of

anteversion : 15°.

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7. Muscular attachment to greater trochanter : Piriformis, gluteus minimus and

medius, obturator internus and externus.

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T
8. Muscular attachment to lesser trochanter : Psoas major, illiacus, adductor

magnus.

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E
9. Femur ossifies from one primary centre (For shaft) and 4 secondary centres.

Primary centre appears at 7th week of intrauterine life.

M
10. Ossification at lower end of femur occurs after the fetus attains viability.

Lower end of the femur is the growing end.

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11. Patella, the largest sesamoid bone develops in the tendon of quadriceps

femoris.
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D
12. Tibia has one primary and two secondary centres for ossification. Primary

centre (shaft) appears at 7 th week of intrauterine life. (like femur)

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13. Secondary centre for upper end of tibia appears just before birth.

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14. Upper end of tibia and lower end femur are common sites of osteomyelitis

but joint is not affected (extracapsular).

E
15. Law of ossification : ossification centre appearing first will fuse last. Fibula

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is an exception to this rule.

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16. Fibula : upper and lower ends are subcutaneous. Common femoral nerve is

in relation to its neck. This is an ideal spare bone for grafting.

17. Talus : It has one centre of ossification. No muscular attachment .Neck

body angle is 150° in adults and 130° - 140° in infants.

18. Sesamoid bones : patella (largest) in tendon of quadriceps femoris, other :-

in tendons of tibialis anterior and posterior, lateral head of gastroc nemius,

gluteus maximus, flexor hallucis brevis.

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 THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY
19. Root value : ilio – inguinal nerve → L1
genitofemoral nerve → L1, L2.
Lateralcutaneous nerve of thigh →L2, L3. Iliohypogastric → L1.

20. Lumbar plexus (L1 – L5).

21. a) Housemaid’s knee : Enlarged prepatellar bursa.

b) Miner’s beat knee : Infected prepatellar bursa.

c) Clergyman’s knee : Enlarged infrapatellar bursa.

22. Illiotibial tract : Thickened lateral part of fascia 5 cm wide. Gluteus maximus

and tensor fascia lata are inserted in the upper part.

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23. Saphenous opening is in fascia lata. 4 cm below and 4 cm cateral to the

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pubic tubercle. It is 2.5 cm X2 cm. Closed by cribriform fascia.

24. Femoral triangle : Bounded laterally by Sartorius, medially by adductor

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longus, base by inguinal ligament. It is continuous below with the adductor

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canal. Femoral vein is medial and femoral nerve is lateral to femoral artery

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(vein – artery – nerve) contents : Femoral artery with branches, femoral vein

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with tributaries, femoral nerve, femoral branch of genitofemoral nerve, lateral

cutaneous nerve of thigh, nerve to pectineus, deep inguinal lymph nodes.

O
25. Anterior wall of femoral sheath is formed by fascia transversalis and

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posterior wall by fascia iliaca.

26. Femoral canal is the medial compartment of femoral sheath (1.5 X 1.5 cm).

D
Upper part/ base is called femoral ring. Femoral canal is wider in females.

E
27. Obturator artery is a branch of internal iliac artery. But, abnormally, it may

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arise from inferior epigastric artery.

28. Muscles in the anterior compartment of thigh are supplied by femoral

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nerve (L2, L3, L4).

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29. Both illiacus and psoas major have common insertion in the lesser

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trochanter. Both are supplied by spinal segments of L2, L3.

30. Adductor canal (= Hunter’s/ subsartorial canal) : An intermuscular space on

the medial side of thigh. Bounded anteriorly by vastus medialis, posteriorly by

adductor longus (above) and magnus (below). Roof is overlapped by Sartorius.

Contents : femoral artery and vein, saphenous nerve, nerve to vastus medialis,

two divisions of obturator nerve.

31. Last branch of femoral artery : descending branch of genicular artery.

32. Quadriceps is an extensor to the knee joint.

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 THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY 3

33. Adductor magnus is supplied by two different motor nerves – obturator

and sciatic nerve. Pectineus also has dual nerve supply – femoral and
obturator. Pictineus has two origins also.
34. Principal nerve supply of adductor compartment : obturator nerve. It is a
branch of lumbar plexus. Root value : L2, L3, L4.
35. Accessory obturator nerve is present in 30% cases. Branch of lumbar
plexus. Root value : L3 , L4.
36. Gluteus maximus is supplied by inferior gluteal nerve whereas gluteus
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medius and minimus are supplied by superior gluteal nerve.

O
37. Gamellus superior is supplied by nerve to obturator internus (L5, S1, S2) and
gamellus inferior is supplied by nerve to Quadratus femoris (L4, L5, S1).
T
38. Tensor fascia lata is supplied by superior gluteal nerve (L4, L5, S1).
N
39. Root value of a) Sciatic nerve - L4, L5, S1 – S3. B) Superior gluteal nerve - L4,
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L5, S1. C) Inferior gluteal nerve – L5, S1, S2. D) Pudendal nerve – S2, S3, S4.

M
40. Popliteal artery : anterior to popliteal vein in knee. Very prone to
aneurysm. B.P. in lower limb is recorded from popliteal artery. Common site of
atherosclerosis.
O
IC
41. Root value of a) Tibial nerve - L4, L5, S1 – S3. (like sciatic nv) b) Common
peroneal - L4, L5, S1, S2.
D
42. Sciatic nerve : Largest branch of sacral plexus. Thickest nerve in the body (2
E
cm). Root value : L4, L5, S1 – S3. Divides into tibial and common peroneal nerves.

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Tibial part supplies → semitendinosus, semimembranosus and long head of
biceps femoris. Common peroneal part supplies → short head of biceps
femoris.
E
H
43. ‘Sleeping foot’ – is due to the compression of sciatic nerve.
44. Principal nerve of the lateral compartment : Superficial peroneal nerve.
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45. Guy ropes : Three muscles – Sartorius, gracillis and semitendinosus are
unitedly called guy ropes.
46. Nerve of illium, ischium and pubis :
nerve of ilium → femoral nerve → supplies sartorius nerve of ischium → sciaHc
nerve →supplies semitendinosus nerve of pubis → obturator nerve → supplies
gracillis. Sartorius in anterior compartment, gracillis in medial compartment
and semitendinosus in posterior compartment.
47. Anserine bursa : separates tendons of gracilis, Sartorius and
semitendinosus. The bursa has several diverticula.

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 THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY 4

48. Peripheral hearts : Soleus muscles in the calf.

49. Sural nerve : Branch of tibial nerve. Root value. L5, S1, S2. It descends
between two heads of gastrocnemius.
50. Root value of a) lateral cutaneous nerve of thigh → L4, L5, S1. B) medial
cutaneous nerve of thigh →L2, L3. c) posterior cutaneous nerve of thigh → S1,
S2, S3. D) saphenous nerve → L3, L4.
51. Muscles of posterior compartment of leg are supplied by tibial nerve.
52. Gastrocnemius and soleus are plantar flexors of foot.
53. The sesamoid bone fabella is in tendon of lateral head of gastrocnemius.

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54. Brodie’s bursa lies deep to : medial head of gastrocnemius and
semimembranosus. May communicate with knee joint.
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55. Tendocalcaneus= Achilles tendon : Thickest and strongest tendon of the

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body- yet vulnerable to frequent rupture. 15 cm long. Formed by tendons of
gastrocnemius and soleus.
56. There are 3 plantar and 4 dorsal interossei. N
E
57. Lateral and medial plantar nerve are branches of tibial nerve.

M
58. There are about 5 perforators along the great saphenous vein and one
along the short saphenous vein.

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59. Perforators of leg : a) thigh → in lower part adductor canal, connecting
femoral vein and saphenous vein b) below knee : connecting great saphenous

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vein and posterior tibial vein c) lateral perforator- at the junction of middle and

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lower thirds of leg d) medial –upper, middle and lower.
60.Trendelenberg test : Varicose veins- superficial veins and perforators are
tested but not deep veins. E
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61. Perthe’s test : is used to test the deep veins. Varicose veins become
distended if the perforators are blocked.

E
62. Superficial inguinal lymph nodes drain the skin and fascia of lower limb,

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perineum, trunk below the umbilicus.
63. Gland of cloquet / Rossenmutller –lies in femoral canal.

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64. Deep inguinal lymph nodes receive afferents from a) superficial inguinal
nodes b) popliteal nodes c) glans penis /clitoris d) deep lymphatics of lower
limb.
65. Sympathetic innervations of lower limb : T10-L2. Fibers arise from lateral
horn cells.
66. Muscles and nerve supply :
a) Hamstrings –sciatic nerve
b) Quadriceps-femoral
c) Adductors – obturator.
d) Triceps – radial.

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 THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY 5

67. Tibia & radius are pre-axial bones and fibula and ulna are post axial bones.
68. Illiofemoral ligament = ligament of Bigelow (Y shaped) is the strongest
ligament of the body.
69. Hip joint : Ball and socket variety of synovial joint. Chief flexor → Psoas and
illiacus. Chief extensor → gluteus maximus and hamstrings. Chief abductors-
gluteus medius and minimus.
70. Coxa vara :neck shaft angle>150° in child and > 127° in adult.

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71. Perthe’s disease : destruction and flattening of femoral head due to
ischaemia. Hyperdense/sclerotic.
O
72. Important lines : a) Shenton’s line : between upper border of obturator
foramen and lower border of neck of femour.
T
N
b) Nelaton’s line : between anterior superior iliac spine and ischial tuberosity.
Passes through the highest part of greater trochanter.
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c) Schoemaker’s line : anterior superior iliac spine and tip of greater
trochanter.
M
73. Relative disruption of lines of Bryant’s triangle is seen in displacement of
greater trochanter.
O
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74. Diseases and age distribution (hip joint).
a) <5 years-congenital dislocation of hip, T-B.
b) 5-10 years – perthe’s ds.
D
E
c) 10-20 years – coxa vara.
75. Knee joint is a compound saddle joint.
M
76. Ligamentum patellae : Central portion of common tendon of insertion of
quadriceps femoris. 7.5 cm long, 2.5 cm wide. Attached to : apex of patella and
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tibial tuberosity.

H
77. a) oblique popliteal ligament is an expansion from tendon of
semimembranosus.
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b) Arcuate popliteal ligament is posterior expansion from short lateral
ligament.
c) Tibial (medial) collateral ligament is degenerated tendon of adductor
magnus.
d) Fibular (lateral) collateral ligament is degenerated tendon of peroneus

longus.

e) Cruciate ligaments are collateral ligaments of femorotibial joints.

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 THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY 6

78. Principal flexors of knee : biceps femoris, semitendinosus,

semimembranosus. Principal extensor →quadriceps femoris.
79.Posterior horn of medial meniscus is more vulnerable to injury due to fixity
to the tibial collateral ligament. Lateral meniscus is protected by poplitius.
80. Anterior cruciate ligament starts in the intercondylar region of tibia and
attached to medial surface of lateral condyle of femur. More commonly
injured-particularly in hyper extension injury and anterior dislocation of tibia.
81. Posterior cruciate ligament: begins in the intercondylar area of tibia,
attached to lateral surface of medial condyle of femur. Less commonly injured.
82. Menisci, cruciate ligaments, tendons, cartilage- all are hypointense (black)
on MRI.
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83. Medial meniscus is semicircular. Posterior margin is continuous with
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transverse ligament and peripheral margin is attached to tibial (medial)
collateral ligament.
T
84. Lateral meniscus is circular. Attached to femur via meniscofemoral
ligaments.
N
E
85. Sinovial membrane of knee lines all aspects except posteriorly where it is
reflected by the cruciate ligaments forming a common covering for ACL and
PCL.
M
86. Bursae around knee : Total 13. 4 anterior, 4 cateral, 5 medial, no posterior.

O
87. Ankle joint is a synovial joint (hinge type).

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88. Deltoid (medial) ligament : Triangular. Both superficial and deep parts have
common attachment to medial malleolus. Crossed by tendons of a) Tibialis
posterior b) Flexor digitorum longus.
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89. a) Principal dorsiflexors of foot : Tibialis anterior (plus excessory : Extensors
and peroneus tertius).
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b) Principal plantar flexors of foot : Gastrocnemius, soleus (plus accessory :
Tibialis posterior and flexors). M
c) Principal everters of foot : peroneus longus, brevis.
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d) Principal inverters of foot : Tibialis anterior and posterior.

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90. Subtalar joint is talocalcaneal joint. Sinovial joint. Separated from
talocalcaneo navicular joint by sinus tarsi.
T
91. Spring ligament = plantar calcaneonavicular ligament.
92. Abnormalities of arch of foot :
a) Pes planus – absence/ collapse of arch.
b) Pes cavus – Exaggerated longitudinal arch (due to spina bifida, polio etc).
c) Talips equinus – walks on toes.
d) Talipes calcaneus – walks on heel.
e) Talipes varus – walks on outer border of foot (foot is inverted and
adducted).
f) Talipes valgus – walks on inner border of foot (everted and abducted).
g) Talipes equinovarus (club foot) : Foot is inverted, adducted + planter flexed
(± associated with spina bifida).

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 THE MEDICO MENTOR

Anatomy Shortlistings.
LOWER EXTREMITY 7

93. Femoral nerve : Root value → L2, L3, L4. Branches in thigh →sartorius,
medial cutaneous nerve of thigh are superficial and branches to vasti (3),
rectus femoris, saphenous as well as hip and knee joints are deep branches.
Test : patellar jerk.
94. Obturator nerve : A branch of lumbar plexus. Root value : L2, L3, L4 (ventral
rami).
Branches : adductors, pectineus, gracillis, obturator externus.
95. Femoral artery, hip, knee joints – are supplied by both femoral and
obturator nerves.
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96. Accessory obturator nerve : present in 30% cases. Root value L3, L4
(ventral). Supplies – pectineus (deep part), hip joint.
O
97. Tibial nerve : Larger terminal branch of sciatic nerve. Root value : L4, L5, S1,
S3 (ventral). T
N
Supplies : gastro – soleus, popiteus, plantaris, tibialis posterior (3P) flexors of

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back of leg oyher branches – sural, medial and middle jeniculars, ankle joint.
Terminal branches are medial and lateral plantars.
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98. Common peroneal nerve : smaller terminal branch of sciatic nerve. Root

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value : L4, L5, S1, S2. Branches : short head of biceps femoris, lateral cutaneous
nerve of calf, lateral geniculars, superficial and deep peroneals. The nerve can

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be rolled against tibular neck. Injury results in foot drop.
99. Muscles having dual nerve supply : Pectineus, adductor magnus, biceps
femoris. D
E
100. Muscles acting on both hip and knee joints : Rectus femoris, Sartorius,
long head of biceps femoris.
M
E
101. Unlocking of knee is done by : Popliteus.

H
102. Inferior tibio fibular joint is a syndesmosis. Calcaneo cuboid joint is a

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saddle joint.

103. Tarsals : a) Talus – no muscular attachment

b) Cuboid – groove for peroneus longus tendon.

104. Movement of hip joint : extension – gluteus maximus, abduction by

gluteus medius, flexion by illiacus, lateral rotation by obturator internus.

105. Medial aspect of leg (skin) is supplied by saphenous nerve. Lateral aspect

by sural nerve.

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